Achieving a Maximally Tolerated beta-Blocker Dose in Heart Failure Patients Is There Room for Improvement?

• Heart failure (HF) is associated with significant morbidity and mortality. Although initially thought to be harmful in HF, beta-adrenergic blockers (beta-blockers) have consistently been shown to reduce mortality and HF hospitalization in chronic HF with reduced ejection fraction. Proposed mechanisms include neurohormonal blockade and heart rate reduction. A new therapeutic agent now exists to target further heart rate lowering in patients who have been stable on a "maximally tolerated b-blocker dose," but this definition and how to achieve it are incompletely understood. In this review, the authors summarize published reports on the mechanisms by which beta-blockers improve clinical outcomes. The authors describe differences in doses achieved in landmark clinical trials and those observed in routine clinical practice. They further discuss reasons for intolerance and the evidence behind using b-blocker dose and heart rate as therapeutic targets. Finally, the authors offer recommendations for clinicians actively initiating and up-titrating b-blockers that may aid in achieving maximally tolerated doses. (C) 2017 by the American College of Cardiology Foundation.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

beta-antagonists

chronic heart failure

dosing

heart rate

randomized controlled-trial

task-force

european-society

elderly-patients

association hfa

blood-pressure

optimize-hf

carvedilol

titration

outcomes

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)